Hybrid Therapy for Atrial Fibrillation - Optimizing Treatment Strategies.

Endocardial atrial fibrillation (AF) ablation techniques enable one to characterize the underlying substrate in order to tailor the ablation procedure but these ablation lesions are not always transmural nor long lasting. Surgical AF ablation techniques, on the other hand, create reliable linear lesions but the lesion set is based on empirical assumptions rather than specific patient characteristics. Performed in combination, both approaches seem to be complementary as they overcome their mutual shortcomings. Several hybrid or convergent ablation strategies with the use of various energy sources have been described. Medium and long term results are encouraging, especially in challenging settings such as persistent AF and failed endocardial catheter ablations.